Greatest Medical Milestone? 'Sanitation,' Says Global Study

A global survey says the biggest medical milestone of the last 150 years is not vaccines, antibiotics, open-heart surgery, or the discovery of DNA.

Quick: What’s the greatest medical milestone of the last 150 years? Is it vaccines? Antibiotics like penicillin? X-ray and MRI imaging? Open-heart surgery? The discovery of DNA?

No, none of the above. The answer is: sanitation. At least that’s the conclusion of a global survey conducted by the British Medical Journal several years ago. This survey isn’t news to people in the water and wastewater business. When such favorable news comes out, those in the profession tend to share it widely, as they should.

Still, it’s worthwhile to look at the survey and its results in a little more depth, in part because inadequate sanitation is still a major problem in parts of the world. Professor Johan Mackenbach of Erasmus University Medical Center in the Netherlands has noted, “In 2001, unsafe water, sanitation and hygiene accounted for over 1.5 million deaths from diarrheal disease in low- and middle-income countries.”

Around the world

The BMJ survey attracted responses from all over the world and from different walks of life. Not surprisingly, since BMJ is a medical publication, doctors gave the most responses at 3,198. But the journal also heard from 2,438 members of the public, 1,582 students, 1,144 academic researchers, and others in a wide range of categories.

It is interesting that, in such a diverse group, sanitation came out in first place. In developed countries, we take sanitation so much for granted that it would be easy to overlook it amid a list of medical miracles. The fact is, sanitation ranked a clear No. 1 with 1,795 responses: 15.8 percent.

It’s also impressive that in a field of respondents led by physicians and researchers who focus on treating disease, so many remembered the importance of preventing it.

Erasing a menace

As part of the BMJ poll, leading doctors and scientists championed each of the 15 milestones. Mackenbach championed sanitation. The Industrial Revolution, starting in the 1780s, caused people to congregate in towns and cities where unplanned growth, poor working conditions and low wages led to a deterioration in public health. “Infectious diseases exacted a huge toll in morbidity and mortality, among them tuberculosis, diphtheria, measles, smallpox, typhoid and typhus, as well as the ‘enteric fevers,’” Mackenbach wrote.

Pandemics of cholera hit western Europe in the 1830s, 1850s and 1860s. A pioneer in sanitation was John Snow, who showed that cholera was spread by water and showed that the shut-off of a particular pump in London stopped the spread of the disease in that area. Another hero was Edwin Chadwick, who came up with the idea to pipe clean water into homes and build sewers to carry wastewater away.

Proof in results

The benefits of improved sanitation were substantial. “Britain took decades to implement these measures and they spread only slowly to the rest of Europe, but in the end they had a major effect on mortality,” Mackenbach wrote.

“In the Netherlands, for example, the first large municipality with piped drinking water was Amsterdam (1854), followed by Rotterdam and The Hague in the 1870s. By the end of the century, around 40 percent of Dutch people had piped drinking water, and in the early 20th century, sewerage systems covered more than half the population.

“Between 1870 and 1970, age-standardized mortality in the Netherlands fell by almost 75 percent. An important contribution to this decline was a fall in the number of deaths from infectious diseases, including deaths from respiratory tuberculosis (down 15 percent), acute respiratory diseases (11 percent), and acute digestive diseases (8 percent).”

Between 1901 and 1970, when a more accurate classification of causes of death was used, a fall in mortality from “diarrhea and dysentery” accounted for 12 percent of the overall decline in mortality in the Netherlands. Similar figures were reported for England and Wales.

Maybe none of this is news to people in the profession. Still, it can only help to be reminded how critically important sanitation is. Things like the results of the BMJ poll can help put a little more spring in your step on the way to work.



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